One patient recovering from COVID-19 finally started eating after a family member was allowed to bring home-cooked meals to a hospital in Fresno. Another patient’s racing heart calmed at a hospital in Monterey when a relative was allowed inside.  

After a year of strict rules that forced many people to abandon their family members at a hospital entrance, many California hospitals are now beginning to crack open their doors to regular visits for non-COVID-19 patients.

Most counties moved this month to less restrictive tiers and the state last week issued new, looser guidelines for hospitals. Now hospitals in 50 counties — home to more than 93% of the population — are eligible to open up to two visitors per patient, with some caveats. 

Some hospitals changed their visitor policies immediately and with enthusiasm. 

Some hospitals, however, are cautiously weighing whether to allow more people inside. Dignity Health, Kaiser Permanente and Sutter Health hospital systems, for example, said that they will continue to reevaluate their visitor policies and could update them soon.

Until two weeks ago, most of California remained in the strictest purple tier, where state health officials advised hospitals to limit visitors to only special cases, such as children and women giving birth. Now only eight counties, with less than 7% of the state’s population, remain in the purple tier.

In addition, the new state guidance increases the number of visitors recommended in non-purple counties to two at a time per patient, provided they’re from the same household and “social distancing can be accomplished.” For all tiers, the number of visitors recommended for children, women giving birth and patients who are dying, undergoing surgery, or have disabilities increased to two.

The guidance doesn’t have the force of law, but a spokesperson for the California Department of Public Health said “hospitals are licensed by CDPH and should comply.” Counties may implement stricter standards if the local public health officer orders them. 

While the guidance doesn’t explicitly mention emergency rooms, a state health department spokesperson said it “applies to visitation for various levels of patient care, including those in emergency room care.” 

Charis Hill, a 34-year-old disabled activist whose immune system is weakened by treatment for an inflammatory disease, came down with a 102-degree fever in August. A friend rushed Hill to the emergency room at Mercy General Hospital in Sacramento, but they were separated at triage. 

Hill spent hours alone in limbo — sweating, shivering and waiting for care. Unable to sit up, a security guard threatened to call the police on Hill for lying down across the chairs in the waiting room, Hill said.

“I felt helpless. I was alone,” Hill said. “I needed someone to advocate for me, to explain my disease that I live with.”

Hill’s friend, who asked not to be named because she works for the state, sat for hours in her car, wearing a respirator because she didn’t know whether Hill was infected with the coronavirus. 

“You’re just wondering what the hell is happening. You know, you’re just kind of stuck in the lurch just thinking is it good, with no information? Is it bad? Like what’s going on?” she said.

When she heard about the security guard’s threats to call the police, she raced into the emergency room to join Hill. “I was going in, come hell or high water,” she said. “COVID be damned. I was going in.” 

William Hodges, a spokesperson for Dignity Health’s hospitals, which include Mercy General, couldn’t comment specifically on Hill’s experience. “We have no record of a complaint or incident report filed by this patient, and therefore, do not have necessary details to determine what may have transpired during the visit,” he said. 

He said the health system is constantly re-evaluating its visitor policies, which at the time allowed one support person in the emergency department. 

Doctors across the state are seeing the benefits of letting family members into hospital rooms and emergency departments. 

Hospitals in counties with high-infection rates worry that in places with widespread infections, people may unknowingly walk into the hospital and bring the coronavirus with them — or contract the virus there and walk back out with it.

The benefits of visitors are especially clear for older adults with cognitive impairments, who are at risk for delirium in hospital settings. 

“I think it’s really vital and important that hospitals see that family caregivers are as integral to the patient outcomes for older patients as they are for children and pregnant women,” said Terri Harvath, a professor and director of the Family Caregiving Institute at UC Davis Health.

“There’s actually strong data that support that older patients, particularly older patients with cognitive impairment, or communication challenges, do better when they have a family caregiver there to support and advocate for them.”

While the state’s policies make allowances for people with physical and cognitive impairments of all ages, there is no exception specifically for older adults, a public health department spokesperson said. 

In the absence of visitors, Tammy Hshieh, an associate physician at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute who has studied delirium, recommends that people keep calling their loved ones.

“It can’t replace human touch, and human presence,” she said. But “that love that you have with each other, those emotions of love and caring or even sadness, patients realize that… these emotions don’t go away.”